Where to Seek Medical Care for Recurring Migraines with Family History
Individuals with recurring migraines and a family history should initially seek care with their primary care physician, as migraine is predominantly diagnosed and managed in the primary care setting. 1, 2
Primary Care as First Point of Contact
Primary care physicians are the appropriate first-line providers for migraine evaluation and management, as initial medical consultations for migraine are usually with a primary care physician and the majority of migraine care occurs in this setting. 1, 2
The medical history is the mainstay of migraine diagnosis, and primary care physicians can systematically apply International Classification of Headache Disorders (ICHD-3) diagnostic criteria through a thorough clinical interview. 1
Family history strengthens the diagnostic suspicion of migraine, as migraine has a strong genetic component with higher prevalence among first-degree relatives, making this an important element to discuss with your primary care provider. 1, 3
What to Expect at the Primary Care Visit
Your primary care physician should document the following essential elements 1, 4:
- Age at onset (migraine typically begins at or around puberty) 1, 4
- Duration of episodes (migraine lasts 4-72 hours) 1, 4
- Frequency (episodic versus ≥15 days/month suggesting chronic migraine) 1, 4
- Pain characteristics: location (unilateral vs bilateral), quality (pulsating), severity (moderate to severe), and aggravating factors 1
- Accompanying symptoms: nausea/vomiting, photophobia, phonophobia 1, 4
- Aura symptoms if present (visual or sensory disturbances lasting 5-60 minutes) 1, 4
- Complete medication history including acute and preventive treatments 1, 4
When to Seek Urgent or Emergency Care
Seek emergency department evaluation immediately if you experience any "red flag" symptoms 1, 5:
- Thunderclap headache ("worst headache of life" with abrupt onset) 1, 5
- Headache awakening you from sleep 1, 5
- New-onset headache after age 50 1, 5
- Focal neurological signs or symptoms 1, 5
- Unexplained fever with neck stiffness 1, 5
- Altered consciousness, memory, or personality 5
- Headache worsened by Valsalva maneuver, coughing, or exertion 1, 5
Urgent Care Centers: A Cautionary Note
Urgent care centers are increasingly used for migraine treatment but often do not follow evidence-based guidelines, with only 12.3% of patients receiving recommended acute migraine medications in one study. 6
Most patients seeking migraine care at urgent care centers (74.4%) were not established within that healthcare system, suggesting fragmented care. 6
Only 11.1% of patients without previous triptan use received triptan prescriptions at discharge from urgent care, indicating suboptimal management compared to primary care. 6
When Specialist Referral is Appropriate
Your primary care physician should refer you to neurology in the following circumstances 5:
- Routine referral (2-4 weeks): Suspected primary headache disorder with uncertain diagnosis or when first-line treatments fail 5
- Urgent referral (within 48 hours): Suspected spontaneous intracranial hypotension or inability to self-care with available help 5
- Emergency admission: Inability to self-care without help or presence of any red flag symptoms 5
Common Pitfalls to Avoid
Do not delay seeking primary care evaluation thinking you need to see a specialist first—primary care physicians can diagnose and manage the vast majority of migraine cases effectively. 2, 7
Avoid medication overuse, defined as taking non-opioid analgesics ≥15 days/month or other acute medications ≥10 days/month for >3 months, as this can transform episodic migraine into chronic migraine. 1, 8
Do not assume urgent care centers provide optimal migraine management—they frequently do not administer or prescribe evidence-based migraine-specific therapies. 6